OT and Self Regulation

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Thursday, July 31, 2014

Today is a good day for research results. Here is a science digest synopsis of research showing that sensory and autism issues can be distinguished from each other using MRI DTI techniques. The entire article is open access and can be found here.

Autism Speaks Science Digest is a great source for keeping track of research findings that affect the day-to-day lives of parents of children with autism. This issue had two interesting articles I'd like to share with you. The first talks about food intolerances and behaviors. The second is about brain inflammation and autism.

You can subscribe to the digest to an email version that shows up twice a month in your mailbox.

Tuesday, February 4, 2014

Big, big news about autism from a very important article, published in Nature, by Wittkowski, et al. The open-access article (you can read it for free!) is a look at the genetics of autism both in terms of finding genetics patterns and in identifying the specific outcomes of those patterns. The authors describe origins of symptoms, cite risk factors, and make important recommendations for very early intervention both with drugs and with lifestyle changes. If you start on page 12 with the discussion, you can avoid the genetics discussions and get to the meat of the paper.

From Rockefeller University, the institute that showed that genes are structurally composed of DNA, comes a statistical approach to looking for the gene groupings that makeup autism. Instead of looking for individual genes shared by children with autism, as past studies have done, Wittkowski, et al, looked for groups of genes; and they did this in large population samples collected from other studies. Using their findings, they proposed a theory outlining the causes of autistic symptoms as well as suggesting drugs and other interventions that can ameliorate those symptoms.

To help identify the groups, they focused on children with epilepsy, a disorder with high co-morbidity with autism and the known problem of the calcium ion channels (which I will not go into here). They contrasted groups of children with and without autism and with particular etiology symptoms and severity of autism. Notably, they were able to pick out the population of children who appear to be developing normally, but who at 24 months begin to regress. They also picked out other sub-populations of autism. They were also able to map severity of symptoms with genetic makeup.

Their findings are consistent with the theory that "increased brain volume, brain connectivity, and skeletal growth correlate with severity of symptoms and suggest impaired inhibition of neuronal growth." They conclude that "ASD is in large part a neurodevelopmental disease ... with symptoms emerging gradually over the first 18 months of life.

Once they identified the gene clusters, they were able to identify the physiological issues and to formulate a theory about the causes of social symptoms of autism.

The authors point out that the very young child with autism is hyper-sensory sensitivity to urban sounds and the ever-present TV and is also overwhelmed with too much social-stimulation from care-givers and preschools. That child is unable to process this rich sensory information and as a result, will avoid eye contact and social scenes. Wittkowski says that social avoidance "leads to underutilization of cortical regions responsible for language and social interaction, which are then pruned ("you don't use it - you lose it").

There is an informative flow chart of the process of accumulating symptoms that is worth viewing. It points out the risk factors and the methods for countering early symptoms and thus changing the outcomes of autism within the first two years of life.

Here are the authors' recommendations:

A shift in focus may be required from intervention in school aged children to early prevention (using medication) starting around 12 months of age, during which time children shape and refine their neural circuitry in response to social stimuli. ...although the American Academy of Pediatrics’ recommendation against television in children under the age of two years stems from studies in a more general population of children, unfavorable neurodevelopmental and behavioral outcomes in children with ASD might be even more compounded by early media exposure. Furthermore, early behavioral and educational interventions may need to favor personnel familiar to the child.

Drugs that target ion channels may decrease hyper-excitation to a level where a child does not feel the need to withdraw from social interaction.

The bottom line of the article is we may be able to seriously change the outcomes of autism.

Sunday, January 12, 2014

There are a few new items worth checking out on the autism page of the Center for Disease Control (CDC).

** Autism Case Training is a program to train health practitioners in "identifying, diagnosing, and managing autism spectrum disorders through real life scenarios." There are 5 training segments with lessons, videos and printable handouts. What I like best is the series of back-to-back videos showing development and behaviors of typical children versus that of children with autism. The training program was developed with pediatricians in mind, but it is valuable for others working with children with ASD.

** The CDC's Seed II Study is conducting a large, multi-state study of the risk factors in autism and developmental delays. The study focuses on the differences in children ages 2-5 with and without autism. It looks at environmental factors, genetics and physiological data including saliva, blood samples and bowel activity.

Monday, December 30, 2013

I have written about EWG before, but let me put in a plug for them one more time. These folks are making a difference.

There is ample evidence that environmental factors are at play in many disorders -- autism is associated with air pollution and landfills. ADHD has known links to lead, pesticides and food additives and coloring. Alzheimer's is similarly affected by toxins in the environment. And of course, there is cancer. Research continues to establish risk factors, but how do we keep track of what is safe?

EWG is a non-profit organization devoted to doing just that. They maintain large data bases of consumer products (cosmetics, soaps, foods, etc.) that provide for each product an overall safety rating, a list of ingredients and associated health and environmental risks due to using that product.

They make the database available to all, and they are easy to use. You can look up products you are using or research new products you intend to buy and make decisions based on factual data as opposed to advertised claims.

EWG does fund raising throughout the year and are currently conducting their year-end drive. They are worthy folks. Check them out at EWG.org. If you like what you see, consider sending them a gift via Paypal at donations@ewg.org.

He begins the book by arguing that we do not have a clear picture of what executive function is. Next he uses logical reasoning and a method derived from the work of evolutionary biologist, Richard Dawkins'(The Selfish Gene) to create a model of executive functioning consisting of five distinct layers or levels that we move through as we develop and mature. Finally, he describes each layer, how it works, what can go wrong and what types of interventions are helpful. The material in this last section rests firmly on the advances of neuropsychological research. Before he has concluded the book, he claims that executive function and self-regulation are equivalent and further claims that ADHD is the chief disorder of executive function.

Here are the five levels:

1. Pre-EF underlies true executive function (EF) in the brain. This is our raw sensing, attention /awareness, motor, emotions, language and our automated responses. We may respond to what we feel, see and hear but do not exert anything but primitive control over our reactions.

2. Self-directed EF is the first level of true EF. With this level's set of skills we create our first set of reactions to what is happening within us and around us. These reactions are directed inward rather than outward to others. This level allows us to regulate our response to our body, emotions and environmental input (via our senses). The functions are:Self-awareness, self-restraint (inhibition), sensory-motor actions, private speech or self-talk, appraisal including calculating the emotional cost of an action, play, reconstitution of memories and thoughts, and problem-solving.

Here is an example: if I am confused and don’t want anyone to know, I will work to keep my face from showing confusion. To the degree that I keep my body still and hide my emotions, no one is privy to what I am feeling.

3. Self-reliant EF gives us the self-management skills necessary to be independent with activities of daily living (ADLS) such as dressing, preparing food, eating and so on. Barkley compares the person operating at this level to Robinson Crusoe who was able to manage his life on his own without social support. However, at this level, we may find ourselves occasionally competing for resources. People operating at this level are performing in a social context, but it is “everyone for themselves.” A child at this level will be competing for toys or play-space during parallel play, or competing with a sibling for a parent’s affection.

4. Tactical-reciprocal EF: At this level, we use social relationships to achieve our goals. We learn to share and we provide mutual help to friends. We learn what it means to be a friend, and we begin to act accordingly. We begin to regulate our actions, emotions, sensory behaviors, and social behaviors for the purpose of successfully interacting with others. For the first time, moral rules come into play.

5. Strategic-cooperative EF is more an extension of tactical-reciprocal EF than a set of new functions. At this level, our actions have a larger scope. We may make career decisions, volunteer to help with a community project, get involved with political activities, or organize a large group for a united goal. The concerns of this level are adult-oriented, but an older teen can begin to work through issues that involve strategic-cooperative EF skills.

Knowing these five levels of executive function can guide those of us who work with children and young adults with ADHD. It helps us select interventions that are appropriate to their EF development level as opposed to their age level. In this way, we can help them move from where they are stuck into the next level of their growth.